scholarly journals Therapeutic drug monitoring in epilepsy clinic: a multi-disciplinary approach

2014 ◽  
Vol 6 (4) ◽  
Author(s):  
Sunee Lertsinudom ◽  
Aporanee Chaiyakum ◽  
Supinya Tuntapakul ◽  
Kittisak Sawanyawisuth ◽  
Siriporn Tiamkao ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Public Health Problem ◽  
Clinical Information ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Therapeutic Level ◽  
Drug Levels ◽  
Drug Level Monitoring ◽  
Level Monitoring

Epilepsy is a common public health problem and needs multi-disciplinary treatment. Therapeutic drug monitoring (TDM) is one of step of the multi-disciplinary treatment in epilepsy at Epilepsy clinic, Khon Kaen University (Thailand). The TDM service has been established since 2008. Here, we aimed to study the roles of TDM order and epilepsy control. This is a prospective descriptive study in which data collection was done from January 1 to December 31, 2010, the period when pharmacists took part in assessing the appropriateness in measurement and interpretation of TDM in order to provide suggestions for physicians. The 112 patients under study had an average age of 38.21±15.36 years; 254 samples were collected for therapeutic drug monitoring; phenytoin was submitted mostly for drug monitoring at 46.46%; 44.49% of sub-missions for drug level monitoring were made owing to a suspected sub-therapeutic level. Associations were found between reasons of sending samples for drug level monitoring and the measured drug levels, <em>i.e.</em>, 66.67% of drug levels found was so low that they were undetectable in sample for patients’ compliance investigation and 38.94% of the drug levels were found to be sub-therapeutic as for the case where submission of samples was done because of suspected sub-therapeutic level, 40% of the cases were found to be in toxicity range in the cases with suspected over-therapeutic levels and monitoring levels, 58.25% were found to be within the therapeutic range. Pharmacists used the interpreted results in patients’ care by recommending physicians to monitor therapeutic drug closely, to adjust the dosage of drugs, and to recommend checking patients’ compliance in their use of drugs at 56.5, 38.9, and 4.3%, respectively. Physicians’ responses were found to be absolute follow, partial follow and not follow at 77.95, 11.03, and 7.48%, respectively. In conclusion, associations were found between reasons of TDM order and measured drug level. Therapeutic drug monitoring services at the Epilepsy Clinic was useful in supporting clinical information queries. Pharmacists could make use of interpreted drug level information by recommending physicians to monitor drug levels and adjust individual dosage regimen accordingly. It should be noted that physicians accepted pharmacists’ recommendation, denoting multi-disciplinary care team that would lead to greater efficiency.

Teicoplanin Therapeutic Drug Monitoring and Treatment Outcomes in Children With Gram-Positive Infections

2021 ◽  
Author(s):  
Georgia Loane ◽  
Amanda Gwee
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Treatment Outcomes ◽  
Drug Monitoring ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Gram Positive ◽  
Retrospective Audit ◽  
Trough Concentrations ◽  
Drug Level Monitoring ◽  
Level Monitoring

Abstract This is a retrospective audit of teicoplanin dosing, drug-level monitoring, and outcomes in 29 children who received 31 courses of teicoplanin. Our study of noncritically ill children showed that the majority (35/43, 81%) of trough concentrations were within the therapeutic range (10-30 mg/L) contrasting previous studies in children. Overall, 21 of the 24 (88%) children with Gram-positive infections achieved cure.

scholarly journals P582 Adalimumab therapeutic drug monitoring: Does time of testing matter?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S488-S488
Author(s):  
S Shields ◽  
J P Seenan ◽  
A Dunlop ◽  
P Galloway ◽  
J Macdonald
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Drug Level ◽  
Drug Dose ◽  
Therapeutic Drug ◽  
Drug Levels ◽  
Clinical Scenarios ◽  
Serum Drug Level ◽  
Inflammatory Bowel ◽  
Fourth Quartile

Abstract Background Whilst anti-TNF drugs such as adalimumab (ADL) have revolutionised the management of inflammatory bowel disease treatment outcomes are not universally favourable with 30% primary non-response (PNR) and 46% secondary loss of response (SLOR) rates reported.1,2 Therapeutic drug monitoring (TDM)—the measurement of serum drug levels and anti-drug antibodies—has become popular with clinicians who use it to optimise biologic therapy through serum drug-level guided dose adjustment. Conventionally TDM is based on the interpretation of trough drug levels (DL) which are obtained by drawing a blood sample immediately prior to the next drug dose. Obtaining an ADL trough DL can be challenging as the drug is administered as a subcutaneous injection usually in the patient’s own home. The aim of this project was to determine the current use of non-trough ADL TDM in clinical practice and determine whether timing of ADL TDM in relation to the next planned dose is clinically important. Methods All ADL DLs performed in 2018 in the Scottish Biologic TDM service3 were identified. DLs were included for patients in sustained clinical remission (SCR), on 40mg every other week dosing, and if the time from the last dose was ≤14 days. TDM performed during induction and for PNR or SLOR were excluded, as were patients on nonstandard dosing or with missing data on dose and interval. Results were analysed by quartile according to time from the last drug dose. Results 338 DLs were included. Median DL is 8µg/ml (range &lt;0.4–36). Median time from last dose is 12 (range 0–14) days. The first quartile (n = 83, median 5 (range 0–7) days) had a median DL of 8.2µg/ml (&lt;0.4–28.1). The second quartile (n = 90, median 11 (8–12) days) had a median DL of 7.9µg/ml (&lt;0.4–36). The third quartile (n = 80, 13 days from last dose) had a median DL of 8µg/ml (&lt;0.4 – 28.1). fourth quartile samples (n = 85, 14 days from last dose – true trough DLs) had a median DL of 8 µg/ml (&lt;0.4–34.8). No relationship was identified between observed DL and the time of DL testing (ρ= -0.3162, p = 0.23). Conclusion It is not necessary to use trough DLs when performing ADL TDM for individuals in SCR. These data should give clinicians the confidence to use opportunistic ADL TDM testing in a clinical setting. Further work should be undertaken on non-trough testing of ADL DLs in other clinical scenarios. Disclosure Biogen GmbH contributed funding for this research. Authors had full editorial control and approval of all content. References

scholarly journals Therapeutic Drug Monitoring in Rheumatic Diseases

2016 ◽  
Vol 16 (2) ◽  
pp. 33-37
Author(s):  
Alexandra NG Hoi-Yan ◽  
Chi Chiu Mok
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Tumor Necrosis ◽  
Drug Efficacy ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Drug Levels ◽  
Underlying Diseases ◽  
Individual Pharmacokinetics ◽  
Necrosis Factor

Abstract The ultimate goal of treating rheumatic disease is to achieve rapid suppression of inflammation, while at the same time minimizing the toxicities from rheumatic drugs. Different patients have different individual pharmacokinetics that can affect the drug level. Moreover, different factors, such as renal function, age or even different underlying diseases, can affect the drug level. Therefore, giving the same dosage of drugs to different patients may result in different drug levels. This article will review the usefulness of therapeutic drug monitoring in maximizing drug efficacy, while reducing the risk of toxicities in Hydroxychloroquine, Mycophenolate Mofetil, Tacrolimus and Tumor Necrosis Factor inhibitors (TNF Inhibitors).

scholarly journals Cure of limb-threatening XDR Pseudomonas aeruginosa infection: combining genome sequencing, therapeutic drug level monitoring, and surgical debridement

2020 ◽  
Author(s):  
Shanti Narayanasamy ◽  
Roger L Nation ◽  
Andrew A Mahony ◽  
M Lindsay Grayson ◽  
Jason C Kwong ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Therapeutic Drug Monitoring ◽  
Drug Level ◽  
Surgical Debridement ◽  
Therapeutic Drug ◽  
Drug Resistant ◽  
Extensively Drug Resistant ◽  
Pseudomonas Aeruginosa Infection ◽  
Drug Level Monitoring ◽  
Level Monitoring

Abstract We describe a case of limb-threatening osteomyelitis and metalware infection with carbapenemase-producing extensively drug-resistant Pseudomonas aeruginosa successfully cured with aggressive surgical debridement and combined intravenous fosfomycin and colistin. Real-time therapeutic drug monitoring was used to maximize probability of efficacy and minimize potential for toxicity.

scholarly journals Therapeutic Drug Monitoring of Antiepileptic Drugs

2008 ◽  
Vol 47 (171) ◽  
Author(s):  
Geeta Shakya ◽  
S Malla ◽  
R Shrestha ◽  
K N Shakya
Keyword(s):  
Valproic Acid ◽  
Therapeutic Drug Monitoring ◽  
Plasma Level ◽  
Antiepileptic Drugs ◽  
Drug Monitoring ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Therapeutic Level ◽  
Toxic Level ◽  
Blood Samples

Commonly used conventional antiepileptic drugs for pharmacotherapy in epilepsy are phenytoin, carbamazepine and valproic acid. These drugs have complex pharmacokinetic properties leading to fluctuation in their plasma level at given same therapeutic dose. The present study was done to monitor their plasma levels. A prospective observational study was conducted at Natoinal Public Health Laboratory. After taking detail history, blood samples were taken from epileptic patients of all age groups and both gender who were on usual therapeutic dose of one or two combined antiepileptic drugs. Plasma level of these drugs were analyzed by using Fluorescence Polarization Immuno Assay (FPIA) technique. Out of total 417 testing, 81were tested for phenytoin , 241 for carbamazepine and 95 for valproic acid. Their levels were further analyzed to find therapeutic, subtherapeutic and toxic levels. Out of total 81 blood samples tested for phenytoin, 38.8% had plasma drug at therapeutic level, 38.8% at subtherapeutic level and 28.4% had toxic level. Carbamazepine was tested in 241 samples and 79.3% cases had at therapeutic drug level, 15.8% had subtherapeutic drug level and 4.9% had toxic level. Out of 95 samples tested for valproic acid, 62% had therapeutic level and 20% had subtherapeutic and 18% had toxic level of drug. Therapeutic drug monitoring of phenytoin showed wide fluctuation in its plasma level. Its toxic and subtherapeutic levels were quite high. It is suggested that the dose of phenytoin should be adjusted after regular plasma level monitoring only. Monitoring of carbamazepine and valproic acid were also helpful when their toxicity and efficacy are doubtful.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):94-97.

scholarly journals P152 Low rates of subtherapeutic drug levels are observed with proactive therapeutic drug monitoring of adalimumab

2021 ◽  
Author(s):  
Stephanie Shields ◽  
John Paul Seenan ◽  
Allan Dunlop ◽  
Peter Galloway ◽  
Jonathan Macdonald
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Drug Levels

Drug level monitoring in palliative patients

2021 ◽  
pp. bmjspcare-2020-002613
Author(s):  
Joanne Bartlett ◽  
Elizabeth Freshwater
Keyword(s):  
Brain Tumour ◽  
Palliative Medicine ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Primary Brain Tumour ◽  
Drug Level Monitoring ◽  
Symptoms And Signs ◽  
Level Monitoring ◽  
Palliative Patients

Palliative medicine is always patient centred and promotes the principle that no unnecessary investigations are performed. The case is reported of a patient with suspected carbamazepine toxicity presenting as progression of symptoms of primary brain tumour. A comparison is made of the symptoms and signs of toxicity versus tumour, and an aid for deciding when to perform therapeutic drug level monitoring for some common drugs.

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